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Review
. 2021 May 28;13(6):1848.
doi: 10.3390/nu13061848.

Polycystic Ovary Syndrome in Insulin-Resistant Adolescents with Obesity: The Role of Nutrition Therapy and Food Supplements as a Strategy to Protect Fertility

Valeria Calcaterra  1   2 , Elvira Verduci  2   3 , Hellas Cena  4   5 , Vittoria Carlotta Magenes  2   6 , Carolina Federica Todisco  2   6 , Elisavietta Tenuta  1 , Cristina Gregorio  4   5 , Rachele De Giuseppe  4   5 , Alessandra Bosetti  2 , Elisabetta Di Profio  2   3 , Gianvincenzo Zuccotti  2   6
Affiliations
Review

Polycystic Ovary Syndrome in Insulin-Resistant Adolescents with Obesity: The Role of Nutrition Therapy and Food Supplements as a Strategy to Protect Fertility

Valeria Calcaterra et al. Nutrients. .

Abstract

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in young reproductive-aged women. PCOS is often associated with obesity and impairs reproductive health. Even though several theories have been proposed to explain the pathogenic mechanism of PCOS, the role of insulin resistance (IR) as a key etiological component, independently of (but amplified by) obesity, is well recognized. The consequent hyperinsulinemia activates excessive ovarian androgen production, leading to PCOS. Additionally, the state of chronic inflammation related to obesity impacts ovarian physiology due to insulin sensitivity impairment. The first-line treatment for adolescents with obesity and PCOS includes lifestyle changes; personalized dietary interventions; and, when needed, weight loss. Medical nutrition therapy (MNT) and the use of specific food supplements in these patients aim at improving symptoms and signs, including insulin resistance and metabolic and reproductive functions. The purpose of this narrative review is to present and discuss PCOS in adolescents with obesity, its relationship with IR and the role of MNT and food supplements in treatment. Appropriate early dietary intervention for the management of adolescents with obesity and PCOS should be considered as the recommended approach to restore ovulation and to protect fertility.

Keywords: adolescents; diet; fertility; food supplements; nutrition; obesity; polycystic ovary syndrome.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Polycystic ovary syndrome development: from fetal life to adolescence. Created with BioRender.com (accessed on 26 May 2021). AMH: anti-Müllerian hormone; LH: luteinizing hormone; GnRH: gonadotropin-releasing hormone.
Figure 2
Figure 2
Insulin resistance and development of polycystic ovary syndrome. Created with BioRender.com (accessed on 26 May 2021). FSH: follicle-stimulating hormone; LH: luteinizing hormone; GnRH: gonadotropin-releasing hormone; SHBG: sex-hormone-binding globulin. FSH: follicle-stimulating hormone; LH: luteinizing hormone; GnRH: gonadotropin-releasing hormone; SHBG: sex-hormone-binding globulin.
Figure 3
Figure 3
Macro- and micronutrients with benefits in polycystic ovary syndrome. Created with BioRender.com (accessed on 26 May 2021). EPA: eicosapentaenoic; DHA: Docosahexaenoic acid; ↑high; ↓low.
Figure 4
Figure 4
Anti-inflammatory properties of DHA and its effects on brain, liver, gut and skeletal muscle. Created with BioRender.com (accessed on 26 May 2021). DHA: Docosahexaenoic acid.
Figure 5
Figure 5
Food supplements and their effects on glucidic and lipidic metabolism and gut microbiota. Created with BioRender.com (accessed on 26 May 2021). HOMA-IR: homeostatic model assessment for insulin resistance; DHA: Docosahexaenoic acid; NAFLD: non-alcoholic fatty liver disease; SCFAs: short-chain fatty acids; TC: total cholesterol; TG: tryglicerides; LDL-C: low-density lipoprotein cholesterol; VLDL-C: very low-density lipoprotein cholesterol; ALT: alanine aminotransferase; HDL-C: high-density lipoprotein cholesterol; QUICKI index: quantitative insulin-sensitivity check index; F/B ratio: Firmicutes (F) and Bacteroidetes (B); T2D = type 2 diabetes; ↑increased; ↓decreased.
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